Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with a chief complaint of insidious onset left shoulder pain, localized to the lateral deltoid region. Pain is exacerbated by overhead activities, reaching, and sleeping on the affected side. No history of acute trauma or dislocation. Reports associated stiffness and weakness with abduction. Symptoms are persistent despite conservative measures including NSAIDs and activity modification.
Clinical Examination Findings
Inspection: No visible atrophy of the supraspinatus or infraspinatus fossae. Palpation: Tenderness noted over the greater tuberosity and bicipital groove. Range of Motion: Active abduction limited by pain; passive ROM preserved. Strength: 4/5 strength on abduction and external rotation, limited by pain. Special Tests: Positive Neerโs impingement sign, positive Hawkins-Kennedy test, and positive Jobeโs (Empty Can) test. Neurovascular: Distal pulses intact, sensation intact to light touch in C5-T1 dermatomes.
Treatment Protocol
Initiate physical therapy focusing on rotator cuff strengthening and scapular stabilization. Prescribe NSAIDs (e.g., Ibuprofen 600mg TID) for inflammation control. Advise activity modification to avoid overhead reaching. Consider subacromial corticosteroid injection if symptoms persist beyond 4-6 weeks. Follow-up in 6 weeks to reassess clinical status and functional improvement.